- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.43 / $259.10 / $2,000.00
| Facility | | $228.43 | $259.10 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.15 / $234.24 / $268.02
| Professional | | $214.15 | $234.24 | $268.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.47 / $564.08 / $666.46
| Professional | | $469.47 | $564.08 | $666.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.98 / $587.35 / $839.68
| Professional | | $339.98 | $587.35 | $839.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.43 / $331.86 / $463.57
| Facility | | $228.43 | $331.86 | $463.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.98 / $481.62 / $1,757.84
| Professional | | $265.98 | $481.62 | $1,757.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.98 / $470.78 / $585.16
| Professional | | $265.98 | $470.78 | $585.16 |